Utilizing a Pediatric Early Warning Tool for Sepsis Screening in a Pediatric Oncology Hospital.

Abstract

Background: Yearly, 75,000 children develop severe sepsis and 7000 die. Immunocompromising conditions and treatment of patients with malignancy put them at higher risk for sepsis. To reduce mortality, morbidity, and onset of severe sepsis in patients at St. Jude Children’s Research Hospital, our team joined the Children’s Hospital Association Improving Pediatric Sepsis Outcomes collaborative. Objectives: Build on an existing Pediatric Early Warning Score scoring tool for clinical deterioration to enhance real-time recognition of septic patients to intervene quickly with appropriate tests and treatment. Methods: A multiprofessional team of over 50 staff and family representatives developed St. Jude specific Sepsis Recognition and Treatment Guidelines. Implemented in the inpatient units in January 2019 and outpatient units in January 2020, the guidelines include sepsis screening, team huddles, intervention algorithms, and order sets. Monthly, sepsis screening, huddles, and interventions are reviewed. Evaluated data include number of sepsis huddles, classification of sepsis huddles, use of order sets, nurse and provider documentation and disposition of patients. Based on data review, SBARs, education, reminders for staff, and numerous PDSA cycles have been implemented. Results: The number of sepsis huddles has steadily increased from 2019 to 2021 (Fig. 1). Order set usage has increased from 14% in first quarter of 2019 to 62% in second quarter of 2021. The number of sepsis-attributable mortalities decreased from 4 in 2017 before sepsis guideline implementation to 0 in 2019 and 2020 (a decrease of 100%). Number of hospital days to treat sepsis declined, patients had fewer days on a ventilator, fewer days on vasoactive medications, and fewer days in the ICU. Identification and treatment of severe sepsis or septic shock cases increased from four in 2018 before implementation to 18 in 2020 (Fig. 2). For sepsis STAT cases in 2019 and 2020, respectively, the sepsis screening tool utilization increased from 93% to 100% (goal, 85%), sepsis huddles were activated in 93% and 100% (goal, 85%), order set utilization increased from 0 to 38% (goal, 85%), time to first IV fluid bolus was 34 and 47 minutes (goal, 20 minutes), and time to first IV antibiotic administration improved from 62 minutes to 44 minutes (goal, 60 minutes). Conclusions: Improving pediatric sepsis outcomes is an on-going quality and patient safety priority for our hospital. We demonstrated that Pediatric Early Warning Score plus screening tool can be successfully utilized in a high-volume pediatric oncology hospital to quickly identify patients with potential sepsis. Early identification and prompt management of sepsis have proven to decrease morbidity and mortality in pediatric hematology, oncology, and transplant patients. Disclosure The authors have no financial interest to declare in relation to the content of this article.Figure 1.: Quarterly number of sepsis huddles, sepsis algorithm category, and percent of huddles where order sets were used.Figure 2.: Number of sepsis cases and sepsis-attributable mortalities in 2017 - 2020.